Pinch points in the consultation - and how to avoid them.

The GP consultation is a fluid, complex interaction that is difficult to define, but points can be identified where the consultation can run smoothly, or rapidly derail and become dysfunctional. In teaching communication skills we can help trainees to recognise these 'pinch points' and to equip them with the tools to successfully navigate the challenges they present. This paper uses the concept of the Two Houses model for the consultation to explore three such pinch points: Keeping the consultation dance going; how 'need' is a power word and should be used with caution; and the value of considering whether the patient is looking for a better understanding of their problem, or a solution, or both. Seeing the consultation as like a dance between doctor and patient can help illustrate the importance of the doctor and patient working together, and for the doctor to be alert to cues that the 'dancers' are drifting apart. The skills needed to keep the dance going throughout the consultation are considered. The perils of telling the patient that they 'don't need' something they believe they do need are explored within the concept of encountering an 'empty room' in the Two Houses model, while the distinction between gaining understanding and seeking a solution is illustrated by considering the Two Wings of the House of Decision within the model.